Anaesthesia for maxillofacial surgery

Introduction: The main challenge of general anesthesia in maxillofacial surgery is the maintenance of airway patency in a specialty where the anatomy of the upper airway can be modified. The aim of our work is to evaluate the anesthetic management of patients operated for maxillofacial reconstruction surgery. Patients and methods: This is a prospective descriptive observational study of six (06) patients operated for maxillofacial reconstruction surgery as part of a mission with a Western team. For each patient, we collected preoperative, intraoperative and postoperative data. Data analysis and processing were performed with Sphinx Plus software (Version: V5.TuiTe). Results: In this report of 06 patients, with a clear female predominance (sex ratio = 0.2) with an average age of 26 years, 66.6% benefited from a mandibulectomy + fibula flap against 33.3% for frontal tumor excision + parietal flap. Preoperatively, no limitation of mouth opening, the Mallampati score was > 2 in 2 patients or (1/3 patients), only one case of anemia at 9.7 g/dl (16.6%) for an average hemoglobin level of 12.4. Intraoperatively, all patients benefited from intravenous induction: rapid sequence in one patient (16.6%), classic sequence in 05 patients (83.3%). The average duration of surgery was 384 min with extremes of 210 min and 615 min. Estimated blood loss was on average 441 ml [50-1000 ml], with a transfusion rate of 50% and a noradrenaline use rate of 16.6% without hemorrhagic shock objectified in our series. Postoperative complications were represented by one or two cases of flap ischemia (33.3%) requiring surgical revision and one case of submaxillary hematoma, i.e. 16.6%. Conclusion: Maxillofacial reconstruction surgery is associated with a success rate that can be improved in our regions. And this requires a unwavering commitment to improving the technical platform as well as continuous training of staff.

Background: Recent advances in anesthesia and the need to manage patients' perioperative anxiety along with escalating healthcare costs have resulted in an increasing number of surgical procedures being performed under local anesthesia (LA) especially as day-case surgeries worldwide. To report our experience with performing oral and maxillofacial surgeries under LA highlighting the advantages and limitations.Patients and Methods: This study was a retrospective analysis of patients who underwent maxillofacial surgical procedures under LA at Murtala Mohammed Specialist Hospital, Kano, Nigeria, over a 2-year period (January 2014–December 2015). Information collated included the patients' demographics, clinical features, diagnosis, surgical operations performed, duration of hospitalization, and complications recorded. The data obtained were analyzed using Statistical Package for Social Sciences version 15.0.Results: A total of 92 patients comprising 58 males and 34 females with varying maxillofacial conditions were operated during the period of the study. Their ages ranged from 12 to 60 years with a mean age of 32 ± 4.4 years. The complications recorded in the patients included three cases of malocclusion (3.2%), one case of wound dehiscence (1.1%), paraesthesia of the lower lip in one patient (1.1%), and cardiac arrest in one patient (1.1%).Conclusion: Maxillofacial surgery under LA is a cost-effective approach to surgery with good outcomes in this environment.

Anesthesia in maxillofacial surgery.

Anaesthesia for maxillofacial surgery

Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage. This definition is widely accepted worldwide by medical practitioners, medical professionals, and public health representatives. The use of local anesthesia allows dental manipulations to be performed painlessly, reversibly blocking the conduction of sensory nerves. Complications related to local anesthesia are an important aspect in dental surgery. The purpose of this literature review is to study the complications associated with the use of local anesthesia in maxillofacial surgery, as well as to investigate methods and procedures for the successful treatment of these complications. This review presents the largest scientific studies conducted in search of the definition of the most common complications and their treatment, since the safety and effectiveness of local anesthesia in dental operations are key aspects in achieving positive results and meeting the needs of patients. Various complications have been identified, including allergic reactions, hematomas, infections, and nerve damage. Regional analgesia is too important to be denied to patients based on a dubious allergic history. Often, adverse reactions can be directly related to the pharmacological properties of the agents involved. The dentist must adequately distinguish these reactions from those that are directly related to allergic phenomena. For the comprehensive management of patients with an allergic history, it is necessary to take into account the importance, as well as the limitations of intradermal skin tests. Most studies have confirmed the relative safety and effectiveness of local anesthesia, but some risks have been noted that require special attention when planning and performing surgical procedures.

Introduction: Nasotracheal intubation (NTI) is preferred for general anesthesia in maxillofacial surgery. However, NTI is often traumatic or even unsuccessful, particularly in patients with a narrow nasal pathway. In this case report, we describe a less traumatic NTI approach using maxillary downfracture of Le Fort I osteotomy. Case presentation: A 19-year-old woman was admitted with a skeletal Class III malocclusion and scheduled to undergo bimaxillary orthognathic surgery. A preoperative evaluation revealed no other medical history and abnormal laboratory findings. Preoperative computed tomography showed nasal septal deviation, concha bullosa, and turbinate hypertrophy. A nasal Ring-Adair-Elwyn endotracheal tube and a tube exchanger could not be inserted via NTI because of her narrow nasal cavity. An oral intubation was performed temporarily and surgery was started. After a maxillary downfracture was performed, which made the nasal cavity wider than before, NTI was successfully conducted without difficulty. The patient was ventilated without any problems, and the operation was continued. Postoperatively, the patient had no further complications and her vital parameters were all stable. Conclusions: This case report suggests that NTI after maxillary downfracture of Le Fort I osteotomy can be a good alternative that can be successfully performed with less trauma in patients undergoing orthognathic surgery who are preoperatively evaluated as having a narrow nasal cavity.

Anaesthesia for maxillofacial surgery

Anaesthesia for maxillofacial surgery

Dexmedetomidine is a selective α2 adrenoreceptor agonist. The drug has a set of useful properties due to wide prevalence of the receptors in a body. The article presents review of the literature of using dexmedetomidine in anesthetic practice of various surgery fields which positive results may be extrapolated to dentistry and maxillofacial surgery to solve important anesthesiologic problems. Inclusion of the drug in routine oral and maxillofacial surgery anesthesia can bring a significant amount of benefits: safe sedation for dental interventions, sedation for compromised airways without respiratory depression, improvement of intraoperative and postoperative analgesia, reduction of postoperative nausea, vomiting and postoperative shivering incidence, nephroprotection and stability of hypotensive hemodynamics, decrease of intraoperative blood loss. Thus, the dexmedetomidine may be a useful agent for anesthesia in oral and maxillofacial surgery that increases anesthesia safety and quality of medical care.

Anaesthesia for maxillofacial surgery

Anaesthesia for maxillofacial surgery

Anaesthesia for maxillofacial surgery

Objective To explore the clinical effect of different doses of dexmedetomidine combined with remifentanil anesthesia in oral and maxillofacial surgery. Methods 135 patients with oral and maxillofacial surgery were randomly divided into three groups according to the random number table method, 45 cases in each group.All patients received dexmedetomidine and remifentanil anesthesia, the dexmedetomidine doses of A, B and C group were 0.4, 0.6, 0.8μg·kg-1·h-1.MAP, HR, SpO2 and Rasmay score in the three groups were observed before administration(T0), after administration of 5min(T1), 10min(T2), 20min(T3), 30min(T4), and the analgesic effects of patients were observed. Results Comparison within the group, the MAP, HR at T0-T4 showed a significant downward trend in all groups, the differences were statistically significant(F=3.651, 3.985, 4.212, all P 0.05). The analgesic effect of C group was significantly better than B group and A group(93.3%, 82.3%)(χ2=3.998, 4.234, all P<0.05). In C group, the incidence rates of hypoxemia, bradycardia(less than 55 times/min) were significantly higher than those of A group and B group (χ2=3.365, 3.112, 3.365, 3.365, all P<0.05). Conclusion In oral and maxillofacial surgery anesthesia, dexmedetomidine combined with remifentanil has good anesthetic effect, with the increase of dexmedetomidine dose, sedative effect is better, but the incidence rate of adverse reaction is increased. Key words: Anesthesia; Dexmedetomidine; Remifentanil; Oral and maxillofacial surgery

An authoritative, evidence based textbook on oral, dental, and maxillofacial surgery: one of the most common indications for anaesthesia worldwide.

Objective To study the effect of shortening the time of initial oral intake and fluid intake after general anesthesia in patients receiving oral and maxillofacial surgery on promotion of postoperative recovery. Methods A total of 116 patients were divided into the control group and the observation group with 58 cases in each group by random digit table from January 2014 to December 2015. Patients in the control group were allowed to take food orally 6 h after they regain analepsia from anesthesia; while those in the observation group were allowed to drink water after 2 h upon analepsia from anesthesia and take liquid food after 4 h. The mis-aspiration, the fasting glucose, blood pressure, heart rate and the rate of hunger, thirst, nausea, vomiting as well as blood pressure and heart rate were observed. Results The rates of hunger, thirst, nausea, vomiting in the observation group were 17.2% (10/58), 5.2%(3/58), 12.1%(7/58), 1.7%(1/58), which were significantly lower than those in the control group, which were 94.8% (55/58), 91.4% (53/58), 36.2% (21/58), 10.3% (6/58), and there were significant differences (χ2=7.484-54.772, all P <0.05). The fasting plasma glucose level in the observation group [(4.93 ± 0.85) mmol/L] was higher than that in the control group [(4.05 ± 0.51 ) mmol/L], and there was significant difference (t=-7.152, P <0.05). There were significant differences in blood pressure 3 h and 5 h after operation compared with those of the control group (P <0.05). Conclusions Shortening the time of taking food for patients undergoing oral and maxillofacial surgery can relieve uncomfortable symptoms, prevent hypoglycemia and the hemodynamic disturbance after anesthesia and promote recovery, early postoperative feeding should be suggested on the premise that they are fully awake. Key words: Anesthesia, general; Hypoglycemia; Fasting time; Oral and maxillofacial surgery